LOMA Event Registration - Columbus


First Name:
Last Name:
Email Address: Email Address Verify:
Company:    If other:
Phone (ex: xxx-xxx-xxxx) :    Extension:


LOMA/LIMRA Designations:
List any new LOMA/LIMRA Designations:

I will pay my $40.00 (Regular Member) or $50 Guest Registration to LOMA Society of Ohio: By Mail At the Door All In Member (no charge)

By Mail to:
Nationwide Financial
Attention: Chris Shenesky
GH-4G-0006
1000 Yard St.
Grandview Heights, OH 43212